Perinatal Mortality In Twins Research Articles

Perinatal Mortality in Twins

Perinatal mortality in twins is found to vary widely in six developed countries for which national data are available. The influence of factors such as birth weight, maternal age, and parity is examined, but no consistent trend is found.

ACUTE POLYHYDRAMNIOS—A COMPLlCATION OF MONOZYGOUS TWIN PREGNANCY

Eight patients with acute polyhydramnios were encountered in 31 103 pregnancies, an incidence of 1 in 3888. All patients with acute polyhydramnios had monozygous twin pregnancies and 14 of the 16 infants were normal. The condition occurred in the second trimester and usually ended in premature delivery within a few days. The perinatal mortality was 100 per cent and accounted for 14.9 per cent of the perinatal mortality in twins.

Developmental Defects and Mortality Rate of Fetuses and Newborns from Multiple Pregnancies

The analysis of 682 newborns indicated that developmental defects accounted for 0.44% of the overall perinatal mortality of twins. The 3.7% higher mortality rate for second twins is frequently due to abnormal presentation and longer time-interval following the birth of the first twin.

Management of twin labor.

Investigations were carried out on 68 labors in twin pregnancies. It was observed that, upon stimulation of uterine contractions by means of oxytocic agents, mainly oxytocin (90%), the mean duration of labor was significantly reduced to about 7 hours, and prolonged labors (over 20 hours) were completely eliminated. The time between delivery of the first and the second baby is now below 30 minutes in all cases, and this is regarded as the optimum time. No neonatal deaths were observed in labors taking place at term. The condition of the newborns at birth was estimated in accordance with the Apgar score and it was found that the second newborn scored worse than the first one; a fact definitely related to the higher proportion of operative procedures during delivery of the second twin (48%) as compared to the first one (10%).The authors stress that, owing to the introduction of the method of conducting twin labors, maternal mortality has been completely eliminated and twin perinatal mortality has been markedly reduced: from about 28% in 1923-1962 to about 10% in recent years.

Perinatal mortality of twin fetuses and newborns.

Out of 446 twin births in 1946-1971, 177 (19.8%) were stillborn or perinatally dead. The main reason of twin perinatal mortality is prematurity, which is also confirmed by clinical and anatomopathologic findings. The essential role in the reduction of perinatal mortality is being attributed to ambulatory “K” Centres through early diagnosis of multiple pregnancy and pregnant women hospitalization at 30-32 weeks of pregnancy.

PERINATAL MORTALITY IN TWINS BY SEX.

PERINATAL MORTALITY IN TWINS BY SEX.

Twin zygosity and placental form in relation to the outcome of pregnancy: Adair Award address

The zygosity of 80 per cent of 293 pairs of twins was established with certainty at birth; a placenta with a single chorion identified 22.8 per cent as monozygotic, differences in sex identified 30.2 per cent as dizygotic, and differences in blood groups of those of the same sex identified an additional 27.0 per cent as dizygotic. The remaining 20 per cent are probably although not positively monozygotic.The data corroborate Weinberg's rule which indicates the total number of dizygotic twins in any population should be twice the number of different sex and that this subtracted from the total should give the number who are monozygotic.Twins have a high mortality which in large measure is due to the high frequency of premature termination of pregnancy. Total neonatal mortality was seven times as great and fetal mortality three times as great for twins as for single infants. Neonatal deaths due primarily to premature delivery accounted for a mortality of 42.5 per 1,000 twin births and only 0.9 per 1,000 total births. However, among infants weighing 1,000 to 2,500 grams the perinatal mortality for twins was 10.5 per cent, for total infants it was 17.5 per cent.Twins known to be monozygous on the basis of monochorionic placentas, identical sex and blood groups had an increased frequency of premature delivery and consequently a greater mortality.Mortality was slightly higher for males (11.7 per cent) than females (9.4 per cent), for twins of like sex (12.2 per cent) than unlike sex (7.3 per cent), for second born (11.8 per cent) than first born (9.3 per cent), and for twins with monochorionic placentas (13.2 per cent) than dichorionic placentas (9.6 per cent).The only conditions that could be considered directly related to the fact of second birth were pneumonia and hyaline membrane disease. These were found in 5 first born and 13 second born. The difference in frequency of these 2 conditions made the only real difference in mortality of first and second twins as delivered at the Chicago Lying-in Hospital.